Imbalance and risk of falling is a common side effect for breast cancer survivors. For years, it was presumed that peripheral neuropathy - nerve damage caused by the chemotherapy - was the primary reason. 

Now, new research led by Dr. Stephen Wechsler, a post-doctoral research fellow in the Cancer Rehabilitation (CaRe) Lab at MGH Institute of Health Professions points to another factor – fatigue. 

The research, representing the first quantified association between imbalance and cancer-related fatigue, was recently published in the journal Rehabilitation Oncology. Wechsler, a 2022 PhD in Rehabilitation Sciences graduate of the Institute, was the lead author. 

“We know that survivors who are fatigued report more frequent falls, but we didn’t know to what extent cancer-related fatigue contributed to changes in balance after cancer treatment,” said Wechsler. “We didn’t know the contribution of fatigue toward imbalance relative to that of chemotherapy induced peripheral neuropathy. Now we have a much better idea.” 

Wechsler’s team tested 43 breast cancer survivors at the IHP’s Biomotion Capture Lab and had them perform functional tests to assess balance. Women with more severe cases of cancer-related fatigue demonstrated more front-to-back swaying when they were standing still. Cancer-related fatigue accounted for about 10% of the variance in postural sway, compared to 1% accounted for by chemotherapy-induced peripheral neuropathy. 

Following the test of static standing balance, the women, who on average were three and a half years removed since their last chemotherapy treatment, performed an exercise to tire their legs. Then they were then asked to perform a sit-to-stand test, a key measure of physical functioning and a predictor of the risk of falling. Women with more fatigue changed their technique when they stood up, using a stabilization strategy in which they didn’t lean forward to generate momentum as much as those with less fatigue. This strategy has also been observed among elderly fallers and is indicative of reduced balance. In this instance, tests revealed that cancer-related fatigue accounted for nearly 7% of the change in postural sway, more than double compared to chemotherapy-induced peripheral neuropathy.

Wechsler and his team say this finding could translate to survivors with cancer-related fatigue having problems performing fatiguing tasks in everyday life including walking long distances, using stairs, exercising, or performing yard work - all of which could increase the risk of someone losing their balance and falling.  

“As clinicians, we’re often only considering peripheral neuropathy as a primary risk factor for imbalance,” said Wechsler. “These numbers justify adding cancer-related fatigue as another factor. We need to consider multi-dimensional impacts of cancer-related fatigue and that includes its impact on balance.”

Wechsler worked with an interprofessional team: Dr. Janet Kneiss, a former assistant professor of physical therapy and a 2014 Doctor of Physical Therapy graduate; Benjamin Adams, an assistant professor of physical therapy; and former nursing professor Dr. Lisa Wood Magee. 

The researchers believe exercise could be a key piece toward improving patients’ balance and reducing their chance of falling. Specifically, the researchers write those patients with cancer-related fatigue after cancer treatment "may benefit from balance-related education regarding safety and coping or compensatory strategies.”

Now that these first-of-its-kind findings put fatigue on the radar, Wechsler says the next steps are determining how to treat imbalance related to cancer-related fatigue. 

“That’s one of the keys here. Fatigue is one of the most common side effects of cancer treatment – most survivors will experience it to some degree. Now that we know it can impact balance, we need to be able to screen for that and intervene while they are recovering.”

This is one of the first research projects from the IHP’s CaRe Lab, which was established earlier in 2022. Designed to investigate the effect of rehabilitation on cancer recovery, it is one of just a small number of research labs in the country focusing on the topic.

Lab director Dr. Kathy Lyons says Wechsler’s research is an important aspect of the CaRe Lab’s applied research portfolio. “The first step in knowing how to treat a problem is to understand the factors causing the problem and the degree to which they are modifiable. This descriptive research is an important step in intervention development and was exactly what we had in mind when we started the lab.” 

Do you have a story the Office of Strategic Communications should know about? If so, email me at: shennessey [at] (shennessey[at]mghihp[dot]edu)

Dr. Stephen Wechsler and Dr. Kathy Lyons have combined their unique clinical perspectives and shared interest in cancer rehabilitation to form the CaRe Lab at the MGH Institute of Health Professions
Dr. Stephen Wechsler and Dr. Kathy Lyons have combined their unique clinical perspectives and shared
interest in cancer rehabilitation to form the CaRe Lab at the MGH Institute of Health Professions